High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation: illustrative case

Sadaf Soloukey; Luuk Verhoef; Pieter Jan van Doormaal; Bastian S Generowicz; Clemens M F Dirven; Chris I De Zeeuw; Sebastiaan K E Koekkoek; Pieter Kruizinga; Arnaud J P E Vincent; Joost W Schouten

doi:10.3171/CASE22177

High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation: illustrative case

Sadaf Soloukey^*, Luuk Verhoef, Pieter Jan van Doormaal, Bastian S Generowicz, Clemens M F Dirven, Chris I De Zeeuw, Sebastiaan K E Koekkoek, Pieter Kruizinga, Arnaud J P E Vincent, Joost W Schouten

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

5 Citations (Scopus)

32 Downloads (Pure)

Abstract

OBJECTIVE: Given the high-risk nature of arteriovenous malformation (AVM) resections, accurate pre- and intraoperative imaging of the vascular morphology is a crucial component that may contribute to successful surgical results. Surprisingly, current gold standard imaging techniques for surgical guidance of AVM resections are mostly preoperative, lacking the necessary flexibility to cater to intraoperative changes. Micro-Doppler imaging is a unique high-resolution technique relying on high frame rate ultrasound and subsequent Doppler processing of microvascular hemodynamics. In this paper the authors report the first application of intraoperative, coregistered magnetic resonance/computed tomograpy, micro-Doppler imaging during the neurosurgical resection of an AVM in the parietal lobe.

OBSERVATIONS: The authors applied intraoperative two-dimensional and three-dimensional (3D) micro-Doppler imaging during resection and were able to identify key anatomical features including draining veins, supplying arteries and microvasculature in the nidus itself. Compared to the corresponding preoperative 3D-digital subtraction angiography (DSA) image, the micro-Doppler images could delineate vascular structures and visualize hemodynamics with higher, submillimeter scale detail, even at significant depths (>5 cm). Additionally, micro-Doppler imaging revealed unique microvascular morphology of surrounding healthy vasculature.

LESSONS: The authors conclude that micro-Doppler imaging in its current form has clear potential as an intraoperative counterpart to preoperative contrast-dependent DSA, and the microvascular details it provides could build new ground to further study cerebrovascular pathophysiology.

Original language	English
Article number	CASE22177
Number of pages	8
Journal	Journal of neurosurgery. Case lessons
Volume	4
Issue number	19
DOIs	https://doi.org/10.3171/CASE22177
Publication status	Published - 7 Nov 2022

Bibliographical note

Acknowledgments
We thank the neurosurgical operating room team of the Erasmus MC in Rotterdam, including Reinier van Els€acker, Willem van ‘t Leven,
Jolanda van den Berg and Josiane Wink-Godschalk. Additionally, we would like to explicitly thank Geert Springeling of the Department of Experimental Medical Instrumentation (EMI) in the Erasmus MC for his help in building the custom intraoperative surgical arm. Funding was received from The Dutch Organization for Scientific Research (NWO), awarded to S.S., P.K., S.K.E.K., C.I.D.Z., A.J.P.E.V., and C.M.F.D., to set up CUBE (Center for Ultrasound Brain Imaging @ Erasmus MC; grant no. 108845); The Netherlands Organization for Scientific
Research (NWO-ALW; grant no. 824.02.001) awarded to C.I.D.Z.; The Dutch Organization for Medical Sciences (ZonMW; grant no. 91120067)
awarded to C.I.D.Z.; Medical Neuro-Delta (grant no. MD 01092019- 31082023) awarded to C.I.D.Z.;
INTENSE LSH-NOW (grant no. TTW/ 00798883) awarded to C.I.D.Z.; and EC|European Research Council (ERCl; grant nos. GA-294775, 737619, and 768914) awarded to C.I.D.Z

Access to Document

10.3171/CASE22177Licence: CC BY-NC-ND

j-neurosurg-case-lessons-article-CASE22177Final published version, 1.35 MBLicence: CC BY-NC-ND

Cite this

Soloukey, S., Verhoef, L., Jan van Doormaal, P., Generowicz, B. S., Dirven, C. M. F., De Zeeuw, C. I., Koekkoek, S. K. E., Kruizinga, P., Vincent, A. J. P. E., & Schouten, J. W. (2022). High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation: illustrative case. Journal of neurosurgery. Case lessons, 4(19), Article CASE22177. https://doi.org/10.3171/CASE22177

@article{6081e72da6c84558855f4b7934a899f9,

title = "High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation: illustrative case",

abstract = "OBJECTIVE: Given the high-risk nature of arteriovenous malformation (AVM) resections, accurate pre- and intraoperative imaging of the vascular morphology is a crucial component that may contribute to successful surgical results. Surprisingly, current gold standard imaging techniques for surgical guidance of AVM resections are mostly preoperative, lacking the necessary flexibility to cater to intraoperative changes. Micro-Doppler imaging is a unique high-resolution technique relying on high frame rate ultrasound and subsequent Doppler processing of microvascular hemodynamics. In this paper the authors report the first application of intraoperative, coregistered magnetic resonance/computed tomograpy, micro-Doppler imaging during the neurosurgical resection of an AVM in the parietal lobe.OBSERVATIONS: The authors applied intraoperative two-dimensional and three-dimensional (3D) micro-Doppler imaging during resection and were able to identify key anatomical features including draining veins, supplying arteries and microvasculature in the nidus itself. Compared to the corresponding preoperative 3D-digital subtraction angiography (DSA) image, the micro-Doppler images could delineate vascular structures and visualize hemodynamics with higher, submillimeter scale detail, even at significant depths (>5 cm). Additionally, micro-Doppler imaging revealed unique microvascular morphology of surrounding healthy vasculature.LESSONS: The authors conclude that micro-Doppler imaging in its current form has clear potential as an intraoperative counterpart to preoperative contrast-dependent DSA, and the microvascular details it provides could build new ground to further study cerebrovascular pathophysiology.",

author = "Sadaf Soloukey and Luuk Verhoef and {Jan van Doormaal}, Pieter and Generowicz, {Bastian S} and Dirven, {Clemens M F} and {De Zeeuw}, {Chris I} and Koekkoek, {Sebastiaan K E} and Pieter Kruizinga and Vincent, {Arnaud J P E} and Schouten, {Joost W}",

note = "Acknowledgments We thank the neurosurgical operating room team of the Erasmus MC in Rotterdam, including Reinier van Els€acker, Willem van {\textquoteleft}t Leven, Jolanda van den Berg and Josiane Wink-Godschalk. Additionally, we would like to explicitly thank Geert Springeling of the Department of Experimental Medical Instrumentation (EMI) in the Erasmus MC for his help in building the custom intraoperative surgical arm. Funding was received from The Dutch Organization for Scientific Research (NWO), awarded to S.S., P.K., S.K.E.K., C.I.D.Z., A.J.P.E.V., and C.M.F.D., to set up CUBE (Center for Ultrasound Brain Imaging @ Erasmus MC; grant no. 108845); The Netherlands Organization for Scientific Research (NWO-ALW; grant no. 824.02.001) awarded to C.I.D.Z.; The Dutch Organization for Medical Sciences (ZonMW; grant no. 91120067) awarded to C.I.D.Z.; Medical Neuro-Delta (grant no. MD 01092019- 31082023) awarded to C.I.D.Z.; INTENSE LSH-NOW (grant no. TTW/ 00798883) awarded to C.I.D.Z.; and EC|European Research Council (ERCl; grant nos. GA-294775, 737619, and 768914) awarded to C.I.D.Z",

year = "2022",

month = nov,

day = "7",

doi = "10.3171/CASE22177",

language = "English",

volume = "4",

journal = "Journal of neurosurgery. Case lessons",

issn = "2694-1902",

publisher = "American Association of Neurological Surgeons",

number = "19",

}

Soloukey, S, Verhoef, L , Jan van Doormaal, P , Generowicz, BS , Dirven, CMF , De Zeeuw, CI, Koekkoek, SKE, Kruizinga, P , Vincent, AJPE & Schouten, JW 2022, 'High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation: illustrative case', Journal of neurosurgery. Case lessons, vol. 4, no. 19, CASE22177. https://doi.org/10.3171/CASE22177

TY - JOUR

T1 - High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation

T2 - illustrative case

AU - Soloukey, Sadaf

AU - Verhoef, Luuk

AU - Jan van Doormaal, Pieter

AU - Generowicz, Bastian S

AU - Dirven, Clemens M F

AU - De Zeeuw, Chris I

AU - Koekkoek, Sebastiaan K E

AU - Kruizinga, Pieter

AU - Vincent, Arnaud J P E

AU - Schouten, Joost W

N1 - Acknowledgments We thank the neurosurgical operating room team of the Erasmus MC in Rotterdam, including Reinier van Els€acker, Willem van ‘t Leven, Jolanda van den Berg and Josiane Wink-Godschalk. Additionally, we would like to explicitly thank Geert Springeling of the Department of Experimental Medical Instrumentation (EMI) in the Erasmus MC for his help in building the custom intraoperative surgical arm. Funding was received from The Dutch Organization for Scientific Research (NWO), awarded to S.S., P.K., S.K.E.K., C.I.D.Z., A.J.P.E.V., and C.M.F.D., to set up CUBE (Center for Ultrasound Brain Imaging @ Erasmus MC; grant no. 108845); The Netherlands Organization for Scientific Research (NWO-ALW; grant no. 824.02.001) awarded to C.I.D.Z.; The Dutch Organization for Medical Sciences (ZonMW; grant no. 91120067) awarded to C.I.D.Z.; Medical Neuro-Delta (grant no. MD 01092019- 31082023) awarded to C.I.D.Z.; INTENSE LSH-NOW (grant no. TTW/ 00798883) awarded to C.I.D.Z.; and EC|European Research Council (ERCl; grant nos. GA-294775, 737619, and 768914) awarded to C.I.D.Z

PY - 2022/11/7

Y1 - 2022/11/7

N2 - OBJECTIVE: Given the high-risk nature of arteriovenous malformation (AVM) resections, accurate pre- and intraoperative imaging of the vascular morphology is a crucial component that may contribute to successful surgical results. Surprisingly, current gold standard imaging techniques for surgical guidance of AVM resections are mostly preoperative, lacking the necessary flexibility to cater to intraoperative changes. Micro-Doppler imaging is a unique high-resolution technique relying on high frame rate ultrasound and subsequent Doppler processing of microvascular hemodynamics. In this paper the authors report the first application of intraoperative, coregistered magnetic resonance/computed tomograpy, micro-Doppler imaging during the neurosurgical resection of an AVM in the parietal lobe.OBSERVATIONS: The authors applied intraoperative two-dimensional and three-dimensional (3D) micro-Doppler imaging during resection and were able to identify key anatomical features including draining veins, supplying arteries and microvasculature in the nidus itself. Compared to the corresponding preoperative 3D-digital subtraction angiography (DSA) image, the micro-Doppler images could delineate vascular structures and visualize hemodynamics with higher, submillimeter scale detail, even at significant depths (>5 cm). Additionally, micro-Doppler imaging revealed unique microvascular morphology of surrounding healthy vasculature.LESSONS: The authors conclude that micro-Doppler imaging in its current form has clear potential as an intraoperative counterpart to preoperative contrast-dependent DSA, and the microvascular details it provides could build new ground to further study cerebrovascular pathophysiology.

AB - OBJECTIVE: Given the high-risk nature of arteriovenous malformation (AVM) resections, accurate pre- and intraoperative imaging of the vascular morphology is a crucial component that may contribute to successful surgical results. Surprisingly, current gold standard imaging techniques for surgical guidance of AVM resections are mostly preoperative, lacking the necessary flexibility to cater to intraoperative changes. Micro-Doppler imaging is a unique high-resolution technique relying on high frame rate ultrasound and subsequent Doppler processing of microvascular hemodynamics. In this paper the authors report the first application of intraoperative, coregistered magnetic resonance/computed tomograpy, micro-Doppler imaging during the neurosurgical resection of an AVM in the parietal lobe.OBSERVATIONS: The authors applied intraoperative two-dimensional and three-dimensional (3D) micro-Doppler imaging during resection and were able to identify key anatomical features including draining veins, supplying arteries and microvasculature in the nidus itself. Compared to the corresponding preoperative 3D-digital subtraction angiography (DSA) image, the micro-Doppler images could delineate vascular structures and visualize hemodynamics with higher, submillimeter scale detail, even at significant depths (>5 cm). Additionally, micro-Doppler imaging revealed unique microvascular morphology of surrounding healthy vasculature.LESSONS: The authors conclude that micro-Doppler imaging in its current form has clear potential as an intraoperative counterpart to preoperative contrast-dependent DSA, and the microvascular details it provides could build new ground to further study cerebrovascular pathophysiology.

UR - http://www.scopus.com/inward/record.url?scp=85162270746&partnerID=8YFLogxK

U2 - 10.3171/CASE22177

DO - 10.3171/CASE22177

M3 - Article

C2 - 36345205

SN - 2694-1902

VL - 4

JO - Journal of neurosurgery. Case lessons

JF - Journal of neurosurgery. Case lessons

IS - 19

M1 - CASE22177

ER -

High-resolution micro-Doppler imaging during neurosurgical resection of an arteriovenous malformation: illustrative case

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this